Direct health care costs and length of hospital stay related to health care-acquired infections in adult patients based on point prevalence measurements

The effectiveness of UV-C radiation for facility-wide environmental disinfection to reduce health care–acquired infections

The prevalence and diagnostic criteria of health-care associated infections in neonatal intensive care units in Turkey: A multicenter point- prevalence study

Background:Outbreaks of healthcare-acquired infections have been linked to contaminated medical devices such as electronic thermometers, sphygmomanometers, stethoscopes, latex gloves, masks, neckties, white coats and other.Objective:The aim of this study was to assess non-critical healthcare tools as a potential source of healthcare-acquired bacterial infections and associated factors in public health hospitals of Harar, eastern Ethiopia from March 2016 to February 2017.Methods:A hospital-based cross-sectional study was conducted on 212 non-critical healthcare tools owned by different health professionals. The data were collected from each owner using self-administered questionnaire. Swab specimens were collected from 187 stethoscopes and 25 sphygmomanometers using sterile cotton tips. Bacterial investigation and antimicrobial susceptibility tests were performed using standard culture tests. The data were double entered into EPI-Data version 3.1 and exported into the Statistical Package for Social Sciences version 16 for analysis.Result:The overall prevalence of non-critical healthcare tool contamination was 53.8%. A total of 137 bacterial strains were isolated. Staphylococcus aureus was the most frequent isolate (35%). Resistance to two or more different classes of antimicrobial was found to be 19.3%. The proportion of stethoscopes or sphygmomanometers contamination owned by the health professionals who were not cleaned regularly before and after examining each patient was found to be high (77%). The majority of non-critical healthcare tools used by health professionals working in the intensive care unit were contaminated (75%) followed by medical wards (73.5%).Conclusion:This study confirmed that the majority of the stethoscopes and sphygmomanometers were contaminated with pathogenic bacteria known to be associated with healthcare-acquired infections. Most of the healthcare workers did not practice stethoscope and sphygmomanometers disinfection. Strict and careful decontamination of stethoscopes and sphygmomanometers need to be in place before use.

Bloodstream infections (BSIs) cause considerable morbidity and mortality. The epidemiology of bacterial infections differs in community and hospital settings. Regular surveillance and reporting of pathogens and antimicrobial susceptibility can assist in appropriate management of BSIs. To describe the distribution of organisms and of antibiotic susceptibility among isolates from blood cultures at a tertiary academic hospital during a 1-year period, stratifying by place of infection acquisition. This was a retrospective descriptive study of bloodstream isolates from cultures from adults (>13 years of age) routinely submitted between 1 October 2011 and 30 September 2012 to the clinical laboratory at Groote Schuur Hospital, Cape Town, South Africa. Community-acquired infections were compared with healthcare-acquired infections, defined as infections developing at least 48 hours after admission or within 3 months of admission to a healthcare facility. Frequencies and proportions of infecting organisms are presented, along with susceptibility results for selected pathogens. The hospital-acquired isolates were stratified by ward (emergency, general medical or general surgical ward or intensive care unit (ICU)) to determine organism frequency and susceptibility patterns by hospital ward. Among adults, 740 non-duplicate pathogens were isolated from BSIs. Nearly three-quarters of infections were healthcare acquired. Enterobacteriaceae and non-fermentative Gram-negative bacilli were predominant among healthcare-acquired pathogens (39.2% and 28.5%, respectively), while Enterobacteriaceae and Gram-positive organisms were the most common among community-acquired pathogens (39.2% and 54.3%, respectively). The majority of community-acquired Enterobacteriaceae were highly susceptible to antibiotics (gentamicin 95.6%, ceftriaxone 96.1% and ciprofloxacin 92.2%), whereas 64.6% of healthcare-associated isolates were susceptible to gentamicin, 58.5% to ceftriaxone and 70% to ciprofloxacin. All community-acquired Staphylococcus aureus isolates v. 52.4% of healthcare-acquired isolates were susceptible to cloxacillin. The susceptibility of healthcare-acquired Pseudomonas aeruginosa and Acinetobacter baumanii complex isolates was <80% to all antibiotics with the exception of colistin. Klebsiella spp., S. aureus and Escherichia coli were the commonest causes of healthcare-acquired infections in all areas outside of the ICUs, whereas Acinetobacter was common in the ICUs and rare in all other areas. The distinction between community- and healthcare-acquired infections is critical in antibiotic selection because narrow-spectrum agents can be utilised for community-acquired infections. The considerable antibiotic resistance of healthcare-acquired pathogens highlights the importance of infection prevention and control. This type of surveillance could be incorporated into routine laboratory practice.

Emergency department (ED) visits are vital components of healthcare delivery, serving as the primary site for acute medical care, particularly for individuals with urgent medical needs. The ED is among the most crowded hospital units. The fast-paced setting and over-crowdedness of an emergency room have become the reality of every hospital across the United States. Overcrowding causes problems for patients and staff, which include the risk of contracting healthcare-acquired infections. This is due to several factors that in most cases lead to an increase in the number of people within the ED, an increase in mortality and morbidity, and a decrease in the ability to provide critical services promptly to patients suffering from medical emergencies. Although the causes of ED overcrowding are complex, the main cause is inadequate inpatient capacity for a patient population with an increasing severity of illness. This study focuses on the over-crowded environment of an Emergency department and the relationship it may have to the increasing number of avoidable health care-acquired infections.

Healthcare acquired infections (HAI) are an important cause of morbidity and mortality in hospitals worldwide. Aim of the study was to analyze nine years surveillance activity, carried out by point prevalence surveys from 2007 to 2015, in a 450-bed teaching hospital in Rome. Point prevalence surveys were carried out every year in the medical and surgical wards following the same methodology. In accordance with definitions used by the Centers for Disease Control, all infections occurred more than 48 hours after hospital admission were considered HAI, and included in the study. Baseline characteristics, clinical features, isolated pathogens (only for the period 2011-2015) and antimicrobial resistance were recorded. During the nine years point prevalence surveys a total 2,840 patients were enrolled. Overall 136 (4.79%) patients developed 180 (6.34%) HAI. The most frequent HAI were respiratory tract infections (RTI), which accounted for 35.0% of all HAI, followed by surgical site infections (SSI) 22.2%, urinary tract infections (UTI) 19.4%, bloodstream infections (BSI) 17.2%, and others 6.1%. HAI related to major invasive risk procedures were also evaluated. SSI/patients undergoing surgery 3.99%, UTI/ patients with urinary catheter 4.17% and BSI/patients with CVC 9.42%. Over one-half of all patients surveyed (1,532, 53.9%) were receiving antibiotics at the time of our study. Among them 892 (58.2%) for treatment, 641 (41.8%) for prophylaxis. In the latter group, 109 (17.0%) underwent extra-short term, 89 (13.9%) short term and 443 (69.1%) a long term prophylaxis. During the period 2011-2015 out of 110 HAI episodes 71 (64.5%) were confirmed microbiologically. In total 106 pathogens were isolates, Gram-negative bacteria (63.2%) were isolated more frequently than Gram-positive bacteria (28.3%). The overall HAI prevalence in our hospital was consistent with those reported in other studies in Italy. The study underlined the role of Gram-negative bacteria in HAI and the need for antimicrobial stewardship. It also provided useful baseline data for rational priorities in allocation of resources, for further infection control activities.

Hospitals will increasingly bear the costs for healthcare-acquired conditions such as infection. Our goals were to estimate the costs attributable to healthcare-acquired infection (HAI) and conduct a sensitivity analysis comparing analytic methods. A random sample of high-risk adults hospitalized in the year 2000 was selected. Measurements included total and variable medical costs, length of stay (LOS), HAI site, APACHE III score, antimicrobial resistance, and mortality. Medical costs were measured from the hospital perspective. Analytic methods included ordinary least squares linear regression and median quantile regression, Winsorizing, propensity score case matching, attributable LOS multiplied by mean daily cost, semi-log transformation, and generalized linear modeling. Three-state proportional hazards modeling was also used for LOS estimation. Attributable mortality was estimated using logistic regression. Among 1253 patients, 159 (12.7%) developed HAI. Using different methods, attributable total costs ranged between $9310 to $21,013, variable costs were $1581 to $6824, LOS was 5.9 to 9.6 days, and attributable mortality was 6.1%. The semi-log transformation regression indicated that HAI doubles hospital cost. The totals for 159 patients were $1.48 to $3.34 million in medical cost and $5.27 million for premature death. Excess LOS totaled 844 to 1373 hospital days. Costs for HAI were considerable from hospital and societal perspectives. This suggests that HAI prevention expenditures would be balanced by savings in medical costs, lives saved and available hospital days that could be used by overcrowded hospitals to enhance available services. Our results obtained by applying different economic methods to a single detailed dataset may inform future cost analyses.

Background: Healthcare-acquired infections (HAIs) that patients develop during the course of healthcare treatment are important causes of morbidity and mortality worldwide. Objectives: The aim of this study was to determine the epidemiology of HAIs in a tertiary-care teaching hospital in Zahedan, southeast Iran. Patients and Methods: This was a cross-sectional study of patients admitted to Ali-Ibn-Abitalib Hospital, a tertiary-care teaching center, from March 2013 through March 2014. All patients admitted during this study period were examined by head nurses on a daily basis for detecting four types of HAIs: surgical site infection, urinary tract infection, pneumonia, and bloodstream infection. All the identified HAIs were registered into the Iranian National Nosocomial Infections Surveillance System Software. Pathogens were identified using standard microbiological methods, and antimicrobial susceptibility was determined by disk diffusion tests according to the Clinical and Laboratory Standards Institute guidelines. Descriptive statistics were used for data analysis. Results: A total of 16,140 patients were admitted to the hospital during the study period, including 162 found to have HAIs (approximately 1%). The majority (79.6%) of the HAIs were reported from the intensive care units (n = 129), followed by the medical wards (10.5%, n = 17) and obstetrics/gynecology ward (7.4%, n = 12). The most common site of infection was the respiratory tract (67.9%) followed by the urinary tract (13.6%). Among the pathogens isolated, Acinetobacter and Enterobacter were the most common (17.6%) followed by Escherichia coli (11%). Overall, multidrug resistance was observed in 95% of the isolates. Conclusions: The HAI prevalence found in this study was lower than HAI rates reported in some other studies from Iran. The isolates showed high resistance to common antibiotics. Guidelines for improving HAI surveillance and stringent measures to reduce the prevalence of multidrug-resistant HAIs must be implemented to reduce the rate and the consequences of HAIs.

Health care-acquired infections (HCAIs) are a major concern for the National Health Service (NHS) and health systems worldwide. At international level, the importance of patient safety has encouraged the development of many new improvement programmes, including practice changes to reduce the risk of patients contracting HCAIs. In the UK, the importance of clinical engagement is emphasized in the Health and Social Care Act (Department of Health (DH), 2008a, p. 2), which states: ‘Effective prevention and control of HCAI has to be embedded into everyday practice and applied consistently by everyone’. This objective was reinforced in the Saving Lives document (DH, 2007a) and the Clean, Safe Care Programme (DH, 2008b), which provide guidance on methods for reducing the burden of HCAIs. Agencies and professional organizations have also had to consider how to avoid overwhelming staff with new initiatives and dealing with competing demands for safer care with higher throughput.

Background Nursing Home Residents (NHR) are the frailest group of older people in society and require a gerontologically attuned approach to address multiple challenges presented to the practitioner. In 2018 we commenced an advanced nurse practitioner (ANP) specialist liaison service with bespoke comprehensive geriatric assessment (CGA) to support NHR admitted to a tertiary referral university teaching hospital. Given the impact of COVID-19 on NHR in particular, in 2020 this service was expanded to include a consultant physician and specialist registrar in geriatric medicine, when full care of NHRs came under geriatric medicine services. This includes a two-week post-discharge virtual clinic with the Nursing Home director of nursing and/or GP. Methods Information on all NHRs attending a tertiary referral university teaching hospital was collected from 2018–2023. Data on demographics, presenting complaints, CGA, and outcomes of Length of Stay (LoS), emergency department (ED) recidivism, and mortality were collected. Impact on clinical outcomes of liaison versus full geriatric medicine care are presented in this abstract. Results In 2018 there were 353 NHRs admitted from ED who represented 4,170 total hospital bed days. In 2019 there were 329 NHRs admitted with 3,991 total bed days. In 2021, 251 NHRs were admitted representing 2,582 total bed days. As result of the enhanced care model, where full inpatient governance came under the geriatric medicine services, we observed: (1) Readmission rate 37% (2018) vs 12.7% (2021), (2) Reduction in LoS from 2018–2021 from 11.8 to 10.0 days, (3) Halved the overall bed-usage days from 2018–2021. Conclusion The high complexity of this cohort of patients requires a timely, comprehensive gerontological approach in order to provide holistic care. Better care with CGA embedded also translates to better use of acute hospital resource.

Resistance to broad-spectrum antibiotics by gram-negative organisms is increasing. Resistance demands more resource utilization and is associated with patient morbidity and death. We describe the implementation of infection reduction protocols, including antibiotic stewardship, and assess their impact on multi-drug-resistant (MDR) healthcare-acquired gram-negative infections. Combined infection reduction and antibiotic stewardship protocols were implemented in the surgical and trauma intensive care units at Vanderbilt University Hospital beginning in 2002. The components of the program were: (1) Protocol-specific empiric and therapeutic antibiotics for healthcare-acquired infections; (2) surgical antibiotic prophylaxis protocols; and (3) quarterly rotation/limitation of dual antibiotic classes. Continuous healthcare-acquired infection surveillance was conducted by independent practitioners using National Heath Safety Network criteria. Linear regression analysis was used to estimate trends in MDR gram-negative healthcare-acquired infections. A total of 1,794 gram-negative pathogens were isolated from healthcare-acquired infections during the eight-year observation period. The proportion of healthcare-acquired infections caused by MDR gram-negative pathogens decreased from 37.4% (2001) to 8.5% (2008), whereas the proportion of healthcare-acquired infections caused by pan-sensitive pathogens increased from 34.1% to 53.2%. The rate of total healthcare-associated infections per 1,000 patient-days that were caused by MDR gram-negative pathogens declined by -0.78 per year (95% confidence interval [CI] -1.28, -0.27). The observed rate of healthcare-acquired infections per 1,000 patient days attributable to specific MDR gram-negative pathogens decreased over time: Pseudomonas -0.14 per year (95% CI -0.20, -0.08), Acinetobacter-0.49 per year (95% CI -0.77, -0.22), and Enterobacteriaceae -0.14 per year (95% CI -0.26, -0.03). Implementation of an antibiotic stewardship protocol as a component of an infection reduction campaign was associated with a decrease in resistant gram-negative healthcare-acquired infections in intensive care units. These results further support widespread implementation of such initiatives.

Health care–acquired infections in neonatal intensive care units: Risk factors and etiology

Anesthesia as a Risk for Health Care Acquired Infections

Rotavirus is the most common etiologic agent of healthcare-acquired diarrhea in pediatric patients. There has been little published information on healthcare-acquired rotavirus infection. This was a retrospective cohort study of children hospitalized with rotavirus gastroenteritis at our institution between December 1999 and May 2004. Patients with community- and healthcare-acquired rotavirus gastroenteritis were compared with regards to age, time of infection, patient unit, and viral subtype as determined by reverse transcription polymerase chain reaction sequencing. Five hundred seventy-seven children were hospitalized with rotavirus gastroenteritis during the study period. One hundred twenty-one (21%) of these infections were healthcare-acquired. The incidence of healthcare-acquired infection was 4.2 cases per 10,000 patient-days. With the exception of 1 outbreak on an isolated patient unit, community- and healthcare-acquired disease affected similar patient populations, had the same temporal distribution, and were caused by viruses with similar subtypes. However, there was a significant difference between the geographic distribution of community- and healthcare-acquired disease within the hospital (P < 0.001). The majority (83%) of community-acquired cases were admitted to general medicine-surgery units, but only 53% of the healthcare-acquired cases occurred on these units (P = 0.005). The remaining healthcare-acquired infections occurred on units that rarely admitted patients with community-acquired disease. Healthcare-acquired rotavirus gastroenteritis seems to be caused by repeated introduction of community strains into the hospital setting. Heightened attention to infection control practices and rapid rotavirus identification is necessary on all units, especially those that infrequently admit children with rotavirus gastroenteritis, to prevent the spread of healthcare-acquired disease.

Child characteristics and health conditions associated with paediatric hospitalisations and length of stay: a population-based study